Many of Mississippi’s rural hospitals and clinics are in danger of shuttering and others are cutting staff, as increased regulations and changes in payment structure make it a challenge to operate these facilities.

But with 1.5 million Mississippians visiting these 175 clinics and 34 hospitals each year, advocates say ensuring their survival should be a top priority.

As a result, last year Gov. Phil Bryant declared Nov. 20 Mississippi Rural Health Day. This year University of Mississippi Medical Center and the Mississippi Rural Health Association each announced awards to celebrate the facilities and doctors who exemplify the best in rural health.

“They’re a vital part of healthcare in Mississippi. They serve over half the state,” said Ryan Kelly, executive director of the Mississippi Rural Health Association. “And it’s hard to look at the news with rural health and not see the financial issues. Rural hospitals are under the gun with so many things and so many regulations placed on them. Uncertainty has been the rule of thumb for 8 to 10 years.”

A glance at the Mississippi Rural Health Association’s quarterly publication highlights this trend: A recent issue includes a notice about the closing of Quitman County Hospital. Another brief announces that Community Health Systems will be selling three rural hospitals in Mississippi in a debt-reduction effort.

According to Kelly, the issues are varied. But many can be traced back to increased regulations with the Centers for Medicare and Medicaid Services as well as Mississippi’s Managed Care Organizations. Nearly 60 percent of rural health patients receive either Medicare or Medicaid benefits. But due to regulatory backups, CMS can take as long as eight or nine months to fully credential a doctor, which means that’s eight or nine months that a doctor isn’t being reimbursed. A large hospital usually has the cash reserves to compensate.

“But a rural health clinic will (hardly) be able to do it at all,” Kelly said. “It’s a real struggle for them to deal with the regulatory burdens and the changes coming in, good and bad, and the costs associated with this. And rural health suffers more because of all of this.”

Other challenges, according to Kelly, include increased requirements for quality reporting and case management, which means hiring more staff. The cost of updating electronic medical records data can be crippling, even for large urban hospitals. In August, Baptist healthcare systems in Jackson and Memphis began merger talks. A key incentive of the deal, according to a press release, is expanding the medical records system used in Memphis to the Jackson hospitals.

In honor of Mississippi Rural Health Day, on Friday, the Mississippi Rural Health Association held a reception honoring 37 rural health clinics and 12 rural hospitals for “outstanding quality.”

“We celebrate this day and the excellent work of our rural facilities in a time where the demands of delivering quality healthcare are extreme. Our providers and facilities have huge demands placed on them, so for our clinics and hospitals to not only meet but exceed the measurable goals placed on them, it should be commended and rewarded,” Kelly said in a statement on Friday.

On Tuesday, the Myrlie Evers-Williams Institute for the Elimination of Health Disparities at the University of Mississippi Medical Center named Dorothy Grady Scarborough the 2016 Rural Health Champion. Scarborough is a registered nurse, the founder of Mississippians Engaging a Greener Agriculture, and co-leader of the Mississippi Farm to School Network, which focuses on the importance of nutrition in the state’s schools.